Heavy cannabis use, neurocognition and PrEP care engagement among young Black sexual minority men

摘要：我们建议进行研究，以确定相关行为对艾滋病毒的影响 预防青年黑人性行为少数男性(YBSMM)，如大量使用大麻。数据来自我们的 该组织和其他人表明，大量使用大麻在YBSMM社区成员中很普遍，而且还在增加， 与HIV感染有关，被当作性药物使用，更有可能成为HIV传播的成员 集群，并减少了艾滋病毒检测。我们建议探索这些机制，特别是对神经认知的影响 大量使用大麻，将大量使用大麻与艾滋病毒预防结果联系起来，以及 在大麻监管、社会接受和法律格局不断变化的情况下，大麻的使用改变了其影响 关于艾滋病毒预防的问题。在拟议的研究中，我们将严格审查大量使用大麻、 神经认知、性行为和PrEP护理投入。首先，我们将阐明大麻的使用对 神经认知--具体地说，大脑系统支持风险/回报(RR)处理，以及更高的阶数 组织职能在YBSMM中统称为执行职能(EF)。第二，我们将探索 大麻的使用如何直接和通过神经认知影响与艾滋病毒预防有关，特别是 准备护理参与度(主要结果)。拟议的研究将整合和扩展这些研究方向 在传统卫生部门和疾控中心支持的艾滋病毒预防方案范围内 位于芝加哥南侧和邻近郊区的YBSMM，是最大的连续多数黑人的家园 美国的人口。我们将使用严格的客观措施来评估大麻的使用情况(例如，量化 血浆中的大麻代谢物)、神经认知(例如，神经成像)和PrEP结果(例如，测量EMR 持久性)，并使用经过验证的调查测量方法对数据进行三角测量。我们还将严格说明其他 物质使用情况，因为使用大麻的YBSMM还使用其他物质(例如酒精)，以及 越来越多的人认识到有必要研究物质使用，因为它发生在现实世界的环境中，包括 多物质使用。我们将在一年半的时间内(3乘以9个月)纵向评估这些因素 280名生活在没有艾滋病毒的YBSMM的队列，以允许检查个体内部的生物变化和 大麻使用的动态性质及其与预防护理结果的关系。我们的目标是：1)确定 大麻使用与神经认知(即神经反应)之间的横向和纵向联系 风险/回报处理和执行职能)在YBSMM队列中；2)全面、直接和间接评估 (通过神经认知)大麻使用和PrEP护理(例如，持久性[主要])和艾滋病毒之间的联系 传播行为(例如，群交[次级])；以及3)决定是否有吸食大麻的动机 修改大麻使用与艾滋病毒预防结果之间的联系。识别神经认知 大麻使用影响艾滋病毒预防的机制和大麻动机的重要性 在了解临床结果方面的使用将为未来的艾滋病毒预防工作提供目标。

ABSTRACT: We propose to conduct research that will determine the impact of relevant behaviors on HIV prevention among Young Black Sexual Minority Men (YBSMM), such as heavy cannabis use. Data from our group and others demonstrate heavy cannabis use as prevalent and increasing in YBSMM community members, is associated with HIV acquisition, use as a sex-drug, greater likelihood of membership in an HIV transmission cluster, and decreased HIV testing. We propose to explore mechanisms, specifically neurocognitive impacts of heavy cannabis use, linking heavy cannabis use to HIV prevention outcomes, and whether motivations for cannabis use, amidst a changing cannabis regulatory, social acceptance and legal landscape, modify its effects on HIV prevention. In the proposed study, we will rigorously examine links between heavy cannabis use, neurocognition, sex behavior and PrEP care engagement. First, we will elucidate the effects of cannabis use on neurocognition - specifically, brain systems supporting risk/reward (RR) processing, as well as higher order organizational functions collectively referred to as executive function (EF) in YBSMM. Second, we will explore how cannabis use, directly and via neurocognitive impacts, is associated with HIV prevention, and particularly PrEP care engagement (primary outcome). The proposed study will integrate and expand these lines of research within the context of traditional health department and CDC supported HIV prevention programs that engage YBSMM in the South Side of Chicago and adjacent suburbs, home to the largest contiguous majority Black population in the US. We will use rigorous objective measures to assess cannabis use (e.g., quantification of cannabis metabolites in plasma), neurocognition (e.g., neuroimaging) and PrEP outcomes (e.g., EMR measured persistence), and triangulate that data using validated survey measures. We will also rigorously account for other substance use, as a proportion of YBSMM who use cannabis also use other substances (e.g., alcohol), and there is increasing recognition of the need to study substance use as it occurs in real-world settings, including polysubstance use. We will assess these factors longitudinally over 1.5 years (3 times 9 months apart) in a cohort of 280 YBSMM living without HIV, to permit examination of within-individual biological changes and the dynamic nature of cannabis use and its association with prevention care outcomes. We aim to: 1) Determine cross-sectional and longitudinal associations between cannabis use and neurocognition (i.e., neural response to risk/reward processing and executive function) in a cohort of YBSMM; 2) Evaluate overall, direct and indirect (via neurocognition) associations between cannabis use and PrEP care (e.g., persistence [primary]) and HIV transmission behaviors (e.g., group sex [secondary]); and 3) Determine whether motivations for cannabis use modify associations between cannabis use and HIV prevention outcomes. Identifying neurocognitive mechanisms through which cannabis use affects HIV prevention and the importance of motivations for cannabis use in understanding clinical outcomes will provide targets for future HIV prevention efforts.